I am seeing sleep issues more and more in clinic now that I am working with the military. Sadly, I did not consider it as often when I was working with a civilian population. I am also guilty of overlooking sleep in my own life. I tend to be pretty consistent on the weekdays, but I fall apart during the weekend, especially after I get offered a beer – one leads to two, two leads to a few! My wife always tells me that it’s hard to get me to go out, but once I’m there it’s impossible to get me to leave, sorry Jeanna! Sleep is obviously important for general health. What is even more fascinating is the impact that sleep can have on pain. We watch movies and listen to rappers like Fifty Cent talk about sleep deprivation like it is the secret to success! Hard work, commitment, discipline, and mindset will drive whatever your definition of success is. Days and days of sleep deprivation, even if it is only hours a night, will catch up to you. It has a name… SLEEP DEBT.
Sleep debt – the difference between your body’s optimal sleep duration (the time your body actually needs each night rather than a general prescription) and the amount of time you are actually sleeping each night.
Experimenting with different amounts of sleep and using a sleep journal can help you find the perfect recipe. In one study by Shingo, Kitamura et al., Estimating Optimal Sleep Duration and Potential Sleep Debt, researchers discovered that participants were often not aware of their surmounting sleep debt. [This next part will take a little more focus so stick with me or scroll to the bottom of this paragraph]. When given a night of recovery sleep (uninterrupted sleep free from light, alarm clocks, and other noises) participants were sleeping almost 12 hours. Over the next 9 days, while forced to live in a laboratory-type setting, uninterrupted sleep time slowly decreased, and by day 4 was an average of 8.41 hours, ranging from 7.29 to 9.26 hours per subject. This was considered the body’s optimal sleep duration. Actually figuring out this number was done using fancy tools to look at brain waves but simply speaking, participants woke up when they felt ready. Interestingly, prior to the study the selected participants reported an average sleep time each day of 7.37 hours (range, 5.82–8.89 hours per subject). Based on the findings from this study, the amount of sleep the participants were getting each night was resulting in about an hour of sleep debt each day. The full recovery from sleep debt took approximately 4 to 9 days.
Sleep debt can have a significant impact on how you feel. If you need more sound data continue reading. Blood samples taken during the study above and others have shown increases in the stress hormone known as cortisol. Poor sleep quality also leads to increased insulin resistance – a precursor to type 2 diabetes and fluctuations in thyroid levels – resulting in reduced metabolic efficiency (how optimally your heart, brain, lungs, liver and other organs function).
POOR SLEEP CAN INCREASE THE INTENSITY OF PAIN
Numerous studies continue to make the connection between sleep and pain. On one hand, increased pain can worsen sleep. On the other hand, poor sleep can increase the intensity of pain. In a study performed on rats, our furry ancestors (just making sure you are still with me!), sleep deprivation followed by an injection to the leg resulted in pain that lasted nearly 21 days and actually resulted in hypersensitivity of the opposite leg, as well. In rats that were provided a recovery day of sleep prior to the injection, pain was only felt locally at the injection site with lower hypersensitivity and a quicker recovery. Studies in humans have shown similar findings. (Sivertsen, B et al.)
DEFICITS IN SLEEP CAN RESULT IN FEELINGS OF DEPRESSION
If you find yourself struggling to meet up with the guys for pick-up basketball or take morning walks with your significant other, you need to consider the LARGE impact that sleep is having on these decisions. What’s even more interesting is that deficits in sleep can result in feelings of depression. Harvard health publications reported that “people with chronic pain have three times the average risk of developing psychiatric symptoms, usually mood or anxiety disorders and depressed patients have three times the average risk of developing chronic pain.”
REGARDLESS OF HOW MUCH SLEEP YOU THINK YOU NEED EACH NIGHT, OR HOW GOOD YOU THINK YOU FEEL AFTER A NIGHT OF SLEEP, YOU MAY BE MISSING WHAT YOUR BODY OPTIMALLY NEEDS TO ALLOW YOU to FEEL AT YOUR BEST.
Find your OPTIMAL SLEEP TIME:
- Starting today, get to bed early enough to allow for at least 12 hours of sleep.YES, this sounds unrealistic but massive action is required for massive change. If you have kids, get them to bed earlier too. They will benefit from this plan just as much, if not more than you. This is not to say that you will actually need 12 hours of sleep. You might find yourself waking up naturally in less time.
- Over the course of the next 7 days give yourself a window that would allow for at least 10 hours of sleep. At some point you will start noticing a trend in how long you are sleeping. This would be considered your optimal sleep duration.
- Similar to the study mentioned above, from day 4 to 7, we would expect you to consistently sleep around the same duration of time without any assistance from alarm clocks or a snoring spouse. Remember that you can set an alarm clock to wake you up at the latest possible hour based on your work needs, but leave yourself at least 10 hours to let your body figure out when it wants to wake up.
THE DONALD MAY ONLY NEED 5 HOURS OF SLEEP WHILE YOUR NEIGHBOR JOE BLOW FROM IDAHO NEEDS 9 HOURS BEFORE HE CAN EFFICIENTLY PLANT HIS POTATOES.
If you want to avoid the process of finding your optimal sleep time, you can try to incorporate Harvard Health’s recommendation:
- Settle short-term debt:If you missed 10 hours of sleep over the course of a week, add three to four extra sleep hours on the weekend and an extra hour or two per night the following week until you have repaid the debt fully.
- Address a long-term debt:Plan a vacation with a light schedule and few obligations. Then, turn off the alarm clock and just sleep every night until you awake naturally.
WHY DO WE CONTINUE TO SEARCH FOR COMPLICATED SOLUTIONS TO SIMPLE PROBLEMS?
Dave Ramsey immediately comes to mind when I think about problems such as these. He continues to positively impact the finances of hundreds of thousands of people throughout the world by simply focusing on the basics: Sticking to a budget and not spending more than you have.
THINKING THAT YOU CAN ELIMINATE PAIN WHILE NEGLECTING SLEEP, EXERCISE AND NUTRITION IS LIKE THINKING YOU’RE GOING TO GET RICH BY RELYING ON CREDIT CARDS TO BUY YOUR LOTTERY TICKETS. SOONER OR LATER IT IS GOING TO BITE YOU IN THE ASS!
I would highly recommend a sleep diary to help you determine how your daily habits impact the quality of your sleep.
- Sleep deprivation can intensify pre-existing pain
- Sleep deprivation can increase feelings of depression and anxiety
- Finding the right amount of sleep can be done by determining your sleep debt
- Sleep can make your rich! (Maybe….)
If you have truly tried all of these recommendations without success, by all means please see a medical professional. I am regularly exposed to men and women who have sustained injuries while deployed during a time of war. Most of them return with symptoms of post-traumatic stress. To keep themselves and their fellow soldiers safe they depended on stimulants (i.e. tobacco and caffeine) and hyper-vigilant behaviors. Reintegrating back into their previous lifestyle upon return home is heavily impacted by the habits developed overseas and symptoms associated with post-traumatic stress. We all have challenges in our lives that can inflict harm on our state of mind. It may require professional help to get over these challenges. Doing so can greatly impact how you feel. If you have any questions please message us and we will respond right away!
Michael Infantino, DPT
(1) Yong Liu, MD, MS, Anne G. Wheaton, PhD, Daniel P. Chapman, PhD, MSc, Janet B. Croft, PhD; Sleep Duration and Chronic Diseases among US Adults Age 45 Years and Older: Evidence From the 2010 Behavioral Risk Factor Surveillance System. Sleep 2013; 36 (10): 1421-1427. doi: 10.5665/sleep.3028
(2) Kitamura, S., Katayose, Y., Nakazaki, K., Motomura, Y., Oba, K., Katsunuma, R., & … Mishima, K. (2016). Estimating individual optimal sleep duration and potential sleep debt. Scientific Reports, 635812. doi:10.1038/srep35812
(3) Vanini, G. (2016). Sleep Deprivation and Recovery Sleep Prior to a Noxious Inflammatory Insult Influence Characteristics and Duration of Pain. Sleep, 39(1), 133-142. doi:10.5665/sleep.5334
(4) Sivertsen, B., Lallukka, T., Petrie, K. J., Steingrímsdóttir, Ó. A., Stubhaug, A., & Nielsen, C. S. (2015). Sleep and pain sensitivity in adults. Pain, 156(8), 1433-1439. doi:10.1097/j.pain.0000000000000131